| Entity Name: | ALTAVIDA OBSTETRICS AND GYNECOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Apr 2022 (3 years ago) |
| Document Number: | L22000186856 |
| FEI/EIN Number | 88-3791474 |
| Address: | 4061 CANINO CT, WESLEY CHAPEL, FL, 33543, UN |
| Mail Address: | 4061 CANINO CT, WESLEY CHAPEL, FL, 33543, UN |
| ZIP code: | 33543 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609621903 | 2024-04-19 | 2024-08-30 | 4061 CANINO CT, WESLEY CHAPEL, FL, 335436407, US | 25179 SAWYER FRANCIS LN, LUTZ, FL, 33559, US | |||||||||||||||||
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| Phone | +1 813-426-5180 |
| Phone | +1 813-733-3000 |
| Fax | 8137337360 |
Authorized person
| Name | DR. CHRISTINA C GOMEZ |
| Role | PHYSICIAN OWNER |
| Phone | 8134265180 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SMITH DENNIS R | Agent | 4061 CANINO CT, WESLEY CHAPEL, FL, 33543 |
| Name | Role | Address |
|---|---|---|
| SMITH DENNIS R | Manager | 4061 CANINO CT, WESLEY CHAPEL, FL, 33543 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-05-16 |
| Florida Limited Liability | 2022-04-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
